CPT code 43259: Endoscopic ultrasound, diagnostic examination2026 Medicare rate & RVUs in New Mexico

In New Mexico, Medicare pays $197.24 for 43259 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 43259 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 43259 covers

A gastroenterologist or other qualified endoscopist uses an ultrasound-equipped endoscope to examine the upper digestive tract and structures next to it. Typical indications include characterizing a subepithelial mass, evaluating a pancreatic lesion or cyst, assessing bile duct abnormalities, and staging nearby lymph nodes. The examination may cover the esophagus, stomach, and duodenum or jejunum as clinically appropriate, in a hospital outpatient department or endoscopy center.

Report 43259 for the diagnostic ultrasound examination without the separately coded EUS-guided tissue sampling or therapeutic maneuver. Document the indication, areas examined, ultrasound findings, and any sampling or intervention performed; when tissue is obtained under EUS guidance, consider the applicable sampling code, such as 43238. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur together, endoscopy-family pricing applies. Modifier 50 is inappropriate because the examination follows upper-GI anatomy rather than paired sides. Medicare payment is restricted for an assistant at surgery; co-surgeon and team-surgery reporting are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How New Mexico compares for 43259

Across 109 of 109 payment localities, the facility rate for 43259 runs from $184.33 in Arkansas to $261.52 in Alaska. New Mexico pays $197.24. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

43259 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 43259 in every payment locality

How the 43259 rate is calculated

Each of 43259’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 43259

The CMS indicators that decide how 43259 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 43259

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 43259 has changed in New Mexico

Price 43259 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates